Hospitals must now tell you their prices. It may help you plan where to seek care.
But today, let’s talk about how it could save you hundreds or thousands on a bill you’ve already received.
Here is a crib sheet.
Ask for a copy of the itemized invoice.
Former ProPublica reporter Marshall Allen has investigated the healthcare industry for 15 years. His book, “Never Pay the First Bill,” features some of the best advice you’ll find anywhere on how to avoid getting ripped off.
Start with the suggestion made in the title of the book. The first invoice you receive often shows vague totals.
Allen likens it to leaving a grocery store with a receipt saying you spent $ 54.50, but that won’t reveal how much you paid for milk or anything else in your cart.
Ask for an itemized bill every time, he says. You are entitled to it and can obtain it from the hospital or your insurer. You want to know each service, billing code and price.
Now check for errors and price increases.
Sometimes the bills are wild. Allen writes about a woman who was billed $ 1,200 for a pregnancy test. In another case, a biller wanted over $ 300 for a medical exam that never took place.
“If it’s not right and the price isn’t right, well, you dispute the bill,” he said. “Even to the point of suing them in small claims court if necessary.”
If there are errors, demand that the hospital correct them. Use your insurer and, if you have job-sponsored insurance, your employer. After all, your employer also wants to save money.
And ask for your medical file. You may have been billed for services that you did not receive. (Allen’s book offers more details on this.)
Then research the prices. Start on your hospital’s website.
Browse the site for a “price transparency” section. Try to Google the name of the hospital with the phrase “price transparency”. You are looking for a page on its website where you can download the full price list.
Many hospitals don’t make it easy. They embed html code to block their price lists from web searches. I’ve also found that some hospitals bury their price files under obscure titles like “Legal” or “CMS”, make the links oddly small and unobtrusive, or put them in weird corners of a page.
You can find a partial price list or an interactive price quote tool on your hospital’s website. These offer limited information, so keep looking for the full, downloadable spreadsheet.
Federal regulations require your hospital to display it. Some installations are compliant. Others break the rule. If your hospital doesn’t publish a full price list, alert federal authorities by filing a complaint online.
Use billing codes to see what your hospital charges others.
Look in the price file for each of the billing codes on your itemized bill. For each code, the hospital must disclose the price paid in cash and the price of each health plan that has a contract for that service. (You may also see a column titled “Gross,” “Chargemaster,” “Cost,” or “Standard Charges.” These amounts are much higher than the actual prices. Ignore them.)
If the spot price is lower than your price, or if you notice that an insurer is getting a much better deal, ask to pay that amount. You can do this whether or not you have insurance.
“The way our health care system has worked,” Allen said, it’s like “you and I decide we’re going to go to McDonald’s together, and we’re each going to get a Big Mac. And they charge me $ 3 and they charge you $ 10.
“Our responsibility as consumers is to say, ‘This is not fair’,” he said. “I’m not going to allow you to charge me more. … And I don’t care if you and my insurance plan made a deal that I would pay $ 10 for my Big Mac. ‘ “
Other websites also allow you to view prices.
You can also check what other hospitals in your area charge for the same services. It might help build a case if the price you charged is outrageous. Check competitor websites.
Several free tools also help you check specific or average prices in your area. These include the Health Care Cost Institute Guroo site, Healthcare Bluebook, FAIR Health, and Turquoise Health.
Some of these sites will continue to improve as more hospitals comply with the federal pricing rule, allowing data scrapers to gather ever more information.
Some experts also recommend checking what Medicare would charge. A hospital will generally not accept this price for a patient not on Medicare. But he could take, say, 150% or 200%. It could still be a lot better than the number on your bill.
What if the biller doesn’t correct mistakes or move on outrageous prices?
If the healthcare provider refuses to correct mistakes or back down from an outrageous price tag, Allen’s book explains how to block many bills by suing – without hiring a lawyer.
His book gives you the steps to take to gather the evidence you need and go to court for a bill that you can demonstrate to be incorrect or unreasonable.
Tackling unfair bills takes work, and not everyone gets it. But pros like Allen say many do. It’s worth a try since the other options are to write a check someone doesn’t deserve, end up in collections, or be sued.
Remember that the prices are negotiable.
The bottom line is that legal experts say you shouldn’t owe a healthcare provider an unfair amount of money just because the biller likes the price.
Learn more about the legal reasoning behind this, plus other tips for managing your medical bills. here.
The Kansas News Service is a collaboration of KCUR, Kansas Public Radio, KMUW and High Plains Public Radio